Therapies for Children With Autism Spectrum Disorders

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Evidence Table. Therapies for children with ASD Study Inclusion/Exclusion Baseline Description Intervention Criteria/Population Measures Outcomes Author: Intervention: Inclusion criteria: Communication/ Communication/ Unis et al., Single Infusion of either • Aged 3-12 years language: language: 2002 Country: extracted porcine secretin • DSM-IV diagnosis of (2 CU/kg), synthetic autism or PDD-NOS by ADOS communication: ADOS communication US Practice setting: porcine secretin (0.4 μg/kg) or an appropriate volume of placebo over 2 a physician or clinical psychologist Exclusion criteria: score, mean ± SD: G1: 5.6 ± 1.7 G2: 6 ± 1.8 score, mean change (95% CI): G1: -0.2 (-0.8, Academic Intervention setting: Clinic Enrollment period: NR Funding: NIH Author industry relationship disclosures: NR Design: RCT (doubleblind) minutes • Previously received G3: 5.7 ± 2 0.4) Assessments: secretin G1/G2/G3: P = 0.75 G2: -0.2 (-0.8, During 1 week prior to • Any medical condition MacArthur 0.5) infusion (telephone for which autism was vocabulary score, G3: 0.2 (-0.5, 0.8) interview) and 4 weeks considered symptomatic mean ± SD: ANOVA: time & after infusion; Secretin • Had comorbid epilepsy G1: 226.2 ± 242.2 treatment (P = Outcome Survey (SOS) • Receiving psychotropic G2: 225.3 ± 229.4 NS) and ABC-C at 2 weeks drug Rx 6 months prior G3: 245.9 ± 228.3 MacArthur postinfusion and 4 weeks to recruitment G1/G2/G3: P = 0.93 vocabulary score, ADOS-G, EOWPVT-R, • Known allergies to pork EOW vocabulary mean change ABC-C products score, mean ± SD: (95% CI): Groups: G1: 15.2 ± 19.5 G1: 16.5 (-11.7, • NVIQ < 35 G1: biologic secretin G2: 14.9 ± 17.6 44.8) Age, months ± SD: G2: synthetic secretin G3: 14.6 ± 15.1 G2: 12.3 (-5.6, G1: 76.5 ± 25.7 G2: 80.7 G3: placebo G1/G2/G3: P = 0.99 30.2) ± 29.8 G3: 78.3 ± 24.9 Co-interventions held Social Skills: G3: 23.4 (9.7, Mental age, non-verbal stable during treatment: ADOS social score, 37.1) IQ, months ± SD: NR mean ± SD: ANOVA: time (P < Total: 55 ± 13 Frequency of contact G1: 10 ± 2.0 0.01) treatment (P Gender: during study: G2: 9.8 ± 2.3 = NS) NR Telephone interview 1 G3: 9.6 ± 2.1 EOW vocabulary Race/ethnicity: week after infusion; G1/G2/G3: P = 0.78 score, mean NR follow-up assessments 4 Problem behavior: change (95% CI): SES: weeks after infusion ABC total score, G1: 1.2 (-0.4, 2.9) Maternal education: NR Concomitant therapies: parent-rated, mean G2: -0.7 (-2.2, Household income: NR NR ± SD: 0.7) Diagnostic approach: N at enrollment: G1: 61.4 ± 22.1 G3: 2.1 (0.2, 4.1) In study 90 G2: 54.2 ± 24 ANOVA: time & Diagnostic tool/method: N at follow-up: G3: 58.9 ± 32 treatment (P = ADOS-G Total: 85 G1/G2/G3: P = 0.63 NS) Diagnostic category, n G1: 26 ABC total score, Social Skills: (%): G2: 26 teacher-rated, mean ADOS social Autism/PDD-NOS: 85 G3: 33 ± SD: score, mean (100) G1: 54.8 ± 22.3 change (95% CI): Aspergers: NR G2: 56.4 ± 24.0 G1: 0.0 (-0.9, 0.9) Other characteristics: G3: 57.5 ± 20.4 G2: 0.0 (-0.9, 0.9) NR G1/G2/G3: P = 0.90 G3: -0.5 (-1.3, Medical: 0.3) SOS score, teacher- ANOVA: time & rated, mean ± SD: treatment (P = G1: 4.7 ± 1.3 G2: 4.7 ± 1.6 G3: 4.7 ± 1.2 G1/G2/G3: P = 0.99 NS) Unis et al., SOS total score, Problem 2002 (continued) parent-rated, mean Behavior: ± SD: ABC total score, G1: 4.3 ± 1.5 parent-rated, G2: 4.4 ± 1.5 mean change G3: 4.0 ± 1.9 (95% CI): C-386
Evidence Table. Therapies for children with ASD Study Description Intervention Unis et al., 2002 (continued) Inclusion/Exclusion Criteria/Population C-387 Baseline Measures Outcomes G1/G2/G3: P = 0.64 G1: -10.6 (-18.9, - 2.3) G2: -5.2 (-10.0, - 0.3) G3: -5.8 (-12.4, 0.9) ANOVA: time (P < 0.001) treatment (P = NS) ABC total score, teacher-rated, mean change (95% CI): G1: 0.4 (-8.3, 9.1) G2: -7.9 (-16.1, 0.3) G3: -12.0 (-18.2, - 5.7) ANOVA: time (P < 0.01) treatment (P < 0.05) Medical: SOS total score, parent-rated, mean change (95% CI): G1: -0.5 (-0.9, - 0.1) G2: -0.7 (-1.0, - 0.4) G3: -0.5 (-0.9, - 0.1) ANOVA: time (P < 0.001) treatment (P = NS) SOS total score, teacher-rated, mean change (95% CI): G1: -0.2 (-1.0, 0.7) G2: -0.5 (-1.1, 0.0) G3: -0.6 (-1.3, 0.1) ANOVA: time (P < 0.05) treatment (P = NS) Harms: 1 child developed fever and illness after the infusion; protocol was completed, but data not included in the analyses
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Comparative Effectiveness Review Nu
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This report is based on research co
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Acknowledgments We are indebted to
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Therapies for Children With Autism
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Dietary and Other Medical Intervent
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Figures Figure A. Analytic framewor
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Table A. Description of interventio
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Analytic Framework Figure A. Analyt
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Strength of evidence. The degree of
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epetitive behavior showed improveme
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subgroups of children, although the
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We encourage investigators to provi
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9. Remington B, Hastings RP, Kovsho
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46. Green J, Charman T, McConachie
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82. Reaven JA, Blakeley-Smith A, Ni
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120. Masi G, Cosenza A, Mucci M, et
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157. Evangeliou A, Vlachonikolis I,
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Introduction Need for Evidence for
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Interventions intended primarily to
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Table 1. Description of behavioral
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Serotonin reuptake inhibitors. Sero
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Table 3. Description of medical and
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Table 4. Description of allied heal
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Key Questions and Analytic Framewor
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Chapter 4 discusses the results in
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Methods This chapter documents proc
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• Did not present aggregated resu
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Additional behavioral interventions
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1. Did the study employ a group des
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Scoring: Studies minimally had to h
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These ratings of applicability do n
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Figure 2. Disposition of articles a
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• ABA-based approaches including
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education, children in the intensiv
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abilities. This finding is further
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Table 10. Outcomes of early intensi
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forecast behavior; perspective taki
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interaction with peers; outcome mea
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hyperactivity, inattention, challen
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Table 12. Outcomes of RCTs assessin
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Schedule for Affective Disorders an
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SCAS-P=Spence Child Anxiety Scale-P
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Summary of the literature. Jarusiew
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Table 14. Overview of educational s
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on the Ankara Developmental Screeni
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Checklist scores decreased by 8.4 f
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Table 15. Outcomes of studies asses
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evaluated the effects of risperidon
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that this somnolence improved over
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Table 17. Outcomes of RCTs of antip
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Serotonin Reuptake Inhibitors SRIs
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One prospective case series of esci
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Most participants were recruited fr
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Dietary and Other Medical Intervent
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Summary of the literature-other int
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withdrew after the first six weeks;
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therefore described separately belo
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addressed, 85 typically involves on
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In the second paper, 89 treatment s
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Table 25. Overview of CAM studies a
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Teacher and Parent Scales, behavior
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Because of the potentially increase
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Educational Interventions Child cha
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showed diminished response to escit
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oom as the other assessments, so it
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contrast group (n=18) on three meas
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and are based on consideration of f
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Few studies directly comparing the
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Strength of evidence. The strength
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While individual studies of CBT and
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Table 32. Summary of results of edu
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Table 33. Summary of results of med
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strength of this reviewed literatur
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Table 36. Intervention, strength of
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Table 37. Interventions/outcomes wi
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gains. 104 Other studies have seen
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percent of behavioral studies repor
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limited followup, lack of comparati
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individual intervention is warrante
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selecting participants for their st
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studies lacked an arm that consider
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23. Kanner L. Autistic Disturbances
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62. Dosman CF, Drmic IE, Brian JA,
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104. Ben-Itzchak E and Zachor DA. T
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142. Tyminski RF and Moore PJ. The
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177. Aman MG, McDougle CJ, Scahill
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214. Correia CT, Almeida JP, Santos
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252. Akhondzadeh S, Tajdar H, Moham
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290. Dawson G, Rogers S, Munson J,
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Acronyms/Abbreviations ABA Applied
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Appendix A. Exact Search Strings an
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Table A2. PsycINFO search strategie
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Therapies for Children with Autism
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Therapies for Children with ASD Sys
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Appendix C. Evidence Tables Tables
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Evidence Table. Therapies for child
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Page 523 and 524: Evidence Table. Therapies for child
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Page 601 and 602: Evidence Table: Therapies for Child
Page 607 and 608: Appendix D. List of Excluded Studie
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Page 619 and 620: 177. Bakare MO, Agomoh AO, Ebigbo P
Page 621 and 622: 204. Baron-Cohen S, Scott FJ, Allis
Page 623 and 624: 233. Bebko JM, Perry A and Bryson S
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262. Bergmann F, Stepp H, Metzger R
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291. Birkan B, McClannahan LE and K
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319. Boddy F, Rowan EN, Lett D, et
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348. Bouma R and Schweitzer R. The
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376. Broadstock M, Doughty C and Eg
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404. Brudnak MA. Application of gen
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432. Buitelaar JK. Why have drug tr
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460. Butler DE, Nordin IC, L’Ital
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489. Campbell M, Locascio JJ, Choro
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517. Caronna EB, Augustyn M and Zuc
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546. Case-Smith J and Miller H. Occ
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574. Charlop MH, Burgio LD, Iwata B
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602. Cheng CW, Cho SH, Taylor M, et
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631. Cicero FR and Pfadt A. Investi
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662. Collier D and Reid G. A compar
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691. Coskun M, Karakoc S, Kircelli
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718. Cullen LA, Barlow JH and Cushw
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748. Davidovitch M, Holtzman G and
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777. DeLeon IG, Fisher WW and Marhe
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805. Devlin SD, Harber MM. Collabor
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834. Doherty K, Fitzgerald M and Ma
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863. Dudley LL, Johnson C and Barne
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893. Dybvik AC. Autism and the Incl
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924. Elder JH. In-home communicatio
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979. Faja S, Aylward E, Bernier R,
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1008. Ferri R, Elia M, Agarwal N, e
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1037. Fisher W, Kerbeshian J and Bu
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1066. Fragala-Pinkham M, Haley SM a
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1095. Furneaux B. Keeping the balan
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1124. Garcaa-Villamisar D, Wehman P
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1152. Ghezzi PM. Discrete Trials Te
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1180. Goin-Kochel RP, Myers BJ and
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1210. Gordon R, Handleman JS and Ha
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1239. Grimaldi BL. The central role
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1268. Guptill JT, Booker AB, Gibbs
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1296. Hamdan-Allen G. Brief report:
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1324. Hare DJ, Jones JPR and Paine
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1356. Harrison S and Berry L. Valui
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1386. Heilbrun AB, Jr., Blum N and
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1414. Hetzroni OE and Shalem U. Fro
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1443. Holburn CS. Counter the mistr
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1473. Horner RH, Carr EG, Strain PS
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1504. Hughes C, Soares-Boucaud I, H
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1533. Ijichi S and Ijichi N. Beyond
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1562. James SJ, Cutler P, Melnyk S,
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1619. Joyce PR. The medical model-w
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1647. Karmali I, Greer RD, Nuzzolo-
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1673. Kelly AB, Garnett MS, Attwood
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1702. Kielinen M, Linna SL and Moil
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1731. Klin A, Lin DJ, Gorrindo P, e
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1761. Koegel RL and Frea WD. Treatm
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1790. Kolmen BK, Feldman HM, Handen
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1819. Kratochvil CJ, Findling RL, M
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1846. Lam MK and Rao N. Developing
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1874. Lattimore LP, Parsons MB and
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1903. Lee PC. Verification of a sim
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1932. Lerman DC, Vorndran C, Addiso
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1960. Licciardello CC, Harchik AE a
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1989. Liptak GS, Orlando M, Yinglin
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2015. Lorimer PA, Simpson RL, Myles
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2071. MacFarlane JR and Kanaya T. W
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2099. Malone RP, Maislin G, Choudhu
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2127. Marin FZ. CAM versus nucleopl
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2157. Martineau J, Roux S, Adrien J
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2185. Matson JL and Lo Vullo SV. A
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2213. McCabe H. The Importance of P
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2240. McDougle CJ, Holmes JP, Carls
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2296. Merlo LJ, Lehmkuhl HD, Geffke
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2325. Minderaa RB, Anderson GM, Vol
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2385. Morrison RS, Sainato DM, Benc
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2413. Munesue T, Ono Y, Mutoh K, et
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2445. Napolitano DA, Tessing JL, Mc
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2474. Niederhofer H and Pittschiele
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2501. Nwora AJ and Gee BM. A case s
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2530. Olive ML, Lang RB and Davis T
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2559. Owens JA, Rosen CL and Mindel
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2589. Pansegrouw I and Alant E. Com
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2618. Paul C, Williams KE, Riegel K
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2646. Perry R, Nobler MS and Campbe
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2675. Piazza CC, Hagopian LP, Hughe
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2704. Poon L, Partika N and Bolman
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2734. Prizant BM. Speech-language p
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2764. Rapp JT, Vollmer TR, St. Pete
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2792. Reed P, Broomfield L, McHugh
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2908. Rossignol DA. Novel and emerg
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2939. Rutter M, Kreppner J, Croft C
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2967. Sandt D. Social Stories for S
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2994. Scanlon K. Art therapy with a
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3023. Schneider CK, Melmed RD, Bars
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3054. Schwartz IS, Sandall SR, Garf
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3085. Shafer MS, Egel AL and Neef N
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3259. Stephens CE. Spontaneous imit
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3289. Strambi M, Longini M, Hayek J
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3346. Tager-Flusberg H and Calkins
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3376. Taylor I, O’Reilly M and La
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3407. Thunberg G, Ahlsen E and Sand
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Appendix F. Approach to Categorizin
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APPENDIX G. Discussion of Recent Sy
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one a casein free regime. Diets wer
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outcome data as Type 6, defined as
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Yes—no disclosures to make G7 Bai
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Table G1. Characteristics of recent
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Random assignment Appropriate compa
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Study Group design Random assignmen
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APPENDIX I. Applicability Summary T
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Social skills (continued) Domain De
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